Other Ways to Increase Nutritional Intake

In some circumstances, nutritional support can be enhanced by alternative means.

One method involves the infusion of liquid formulas directly into the stomach or small bowel through a small, soft feeding tube. Usually the tube is inserted into the nostril and passed into the stomach each night. It is removed in the morning so that the person can go to school or work. If hospitalisation is required, the infusion may continue on a 24-hour basis. This approach has been used successfully to control inflammation and to improve growth in children either alone or in combination with food intake during the day. As an alternative, some physicians have used night-time gastrostomy feedings.

A gastrostomy is a surgically made opening through the abdominal wall directly into the stomach, through which the feeding tube is passed. The obvious advantage of this type of feeding is that it is not necessary to pass a tube through the nose each night.

When tube feeding is required, the composition of the liquid formula and the amount infused depend upon the needs of the individual. Short-term results (four to six weeks) with nasogastric infusion are usually good, indicating improvement in disease activity and growth. Understandably, the acceptance of tube feeding varies and may be higher in children than in adolescents and adults. However, adolescents may be highly motivated to comply with this regimen once they see consistent increases in weight and height, especially if plotted on standard growth curves.

A second method of supplying nutrient requirements is by vein (intravenous route). This approach bypasses the intestine altogether and "rests" the bowel by decreasing the work of digestion and intestinal blood flow. This method has been called intravenous "hyperalimentation" in the past, but is now called total parenteral nutrition (TPN).

TPN can be used temporarily in hospital or adapted for ongoing use at home. Usually the intravenous administration continues during the night but is stopped in the morning so that the person can go to school or work. TPN is expensive, requires a training program in hospital, and is therefore recommended only in selected situations, such as preparing malnourished patients for surgery, healing severe perianal inflammation or fistulous disease, or reversing growth failure unresponsive to oral nutrition. The technique should be supervised only by a medical team familiar with its management. Currently, this requires a group effort consisting of physician, nurse, nutritionist and pharmacist.

Many approaches are available to maintain or improve the nutritional status of the person with IBD. The easiest and safest methods should be used first whenever possible, with the more invasive approaches reserved for special circumstances. Your continual good nutrition depends upon maintaining communication with your gastroenterologist and with a nutritionist or dietician.
Updated July 2003